Hepatic Resection at a Major Community-Based Teaching Hospital Can Result in Good Outcome
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The relationship between volume and outcome has been established in the literature for several complex surgical procedures. Improved outcome has been suggested at high-volume hospitals or with high-volume surgeons.
The objective of this study was to evaluate the experience of a low-volume hospital with major liver resections. The setting of the study was a community-based teaching hospital with a surgical residency training program.
A total of 46 major liver resections were performed between January 1992 and December 2002. Procedures performed were hepatic lobectomies (n = 15; right, n = 11; left, n = 4), trisegmentectomies (n = 5; right, n = 3; left, n = 2), segmentectomies (n = 16; left lateral, n = 12; right posterior, n = 4), and wedge resections (n = 10). Operations were performed by 14 different surgeons; however, 23 operations were performed by 1 surgeon. Sixteen patients (34%) developed 23 complications. The average length of hospital stay was 9.7 days. There were no 30-day postoperative mortalities. Out of 46 patients who underwent major liver resection over the last 10 years, 13 patients are still alive. Overall survival ranged from 3 to 84 months, with a median survival of 30.6 months. The actual 5-year survival was 36% (8 of 22) for all patients operated on >5 years ago, and the actual 2-year survival was 61% (20 of 33).
Major liver resection can be performed safely with low rates of morbidity and operative mortality with careful selection of patients at a low-volume community-based teaching hospital.
- Finlayson, EV, Goodney, PP, Birkmeyer, JD (2003) Hospital volume and operative mortality in cancer surgery. Arch Surg. 138: pp. 721-6
- Christian, CK, Gustafson, ML, Betensky, RA, Daley, J, Zinner, MJ (2003) The Leapfrog volume criteria may fall short in identifying high-quality surgical centers. Ann Surg. 238: pp. 447-57
- Birkmeyer, JD, Finlayson, EV, Birkmeyer, CM (2001) Volume standards for high-risk surgery: potential benefits of the Leapfrog initiative. Surgery 130: pp. 415-22 CrossRef
- Glasgow, RE, Showstack, JA, Katz, PP (1999) The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch Surg. 134: pp. 30-5
- Begg, CB, Cramer, LD, Hoskins, WJ, Brennan, MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280: pp. 1747-51
- Dimick, JB, Pronovost, PJ, Cowan, JA, Lipset, PA (2003) Postoperative complication rates after hepatic resections in Maryland hospitals. Arch Surg. 138: pp. 41-6 CrossRef
- Ston, ME, Rehman, SU, Conaway, G (2000) Hepatic resection at a community hospital. J Gastrointest Surg. 4: pp. 349-53
- Galperin, EL, Karagulian, SR (1989) A new simplified method of selective exposure of hepatic pedicles for controlled hepatectomies. HPB Surg. 1: pp. 110-7
- Birkmeyer, MD, Stukel, TA, Siewers, AE, Goodney, PP, Wenberg, DE, Lucas, FL (2003) Surgeon volume and operating mortality in the United States. N Engl J Med. 349: pp. 2117-27
- Hannan, EL (1999) The relation between volume and outcome in health care. N Engl J Med. 340: pp. 1677-9
- Davie, RJ (2003) Invited critique. Arch Surg. 138: pp. 726
- Harmon, JW, Tang, DG, Gordon, TA (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg. 230: pp. 404-13
- Petrelli, NJ, Gupta, B, Piedmonte, M, Herrera, L (1991) Morbidity and survival of liver resection for colorectal adenocarcinoma. Dis Colon Rectum 34: pp. 899-904
- Jarnagin, WR, Gohen, M, Fong, Y (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1800 consecutive cases over the past decade. Ann Surg. 236: pp. 397-407
- Halm EA, Lee C, Chassin MR. Appendix A: volume and outcome in cancer surgery. In: How Is Volume Related to Quality in Health Care: A Systemic Review of the Research Literature. Washington, DC: National Academic Press, 2001:13–32.
- Hepatic Resection at a Major Community-Based Teaching Hospital Can Result in Good Outcome
Annals of Surgical Oncology
Volume 12, Issue 2 , pp 133-137
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Christiana Care Health Services, Helen F. Graham Cancer Center, 4701 Ogletown-Stanton Road, Suite 1213, Newark, Delaware, 19713